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Robinson CG, Coleman T, Buciuc M, Singh NA, Pham NTT, Machulda MM, Graff-Radford J, Whitwell JL, Josephs KA. Behavioral and Neuropsychiatric Differences Across Two Atypical Alzheimer's Disease Variants: Logopenic Progressive Aphasia and Posterior Cortical Atrophy. J Alzheimers Dis 2024; 97:895-908. [PMID: 38143349 PMCID: PMC10842893 DOI: 10.3233/jad-230652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) and logopenic progressive aphasia (LPA) are two common atypical Alzheimer's disease (AD) variants. Little is known about behavioral and neuropsychiatric symptoms or activities of daily living (ADLs) in PCA and LPA, and whether they differ across syndromes. OBJECTIVE To characterize the behavioral and neuropsychiatric profiles and ADLs of PCA and LPA and compare presence/absence and severity of symptoms between syndromes. METHODS Seventy-eight atypical AD patients, 46 with PCA and 32 with LPA, completed the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Cambridge Behavioral Inventory-Revised (CBI-R) at baseline and longitudinally over-time. Mann-Whitney U and Fisher's Exact Tests assessed for differences in symptoms between the two syndromes with significance set at p≤0.01. To eliminate demographic differences as confounders the groups were matched, and differences reanalyzed. RESULTS PCA were younger at onset (p = 0.006), at time of baseline assessment (p = 0.02) and had longer disease duration (p = 0.01). Neuropsychiatric symptoms were common in PCA and LPA, although more common and severe in PCA. At baseline, PCA had a higher NPI-Q total score (p = 0.01) and depression subscore (p = 0.01) than LPA. Baseline total CBI-R scores were also higher in PCA than LPA (p = 0.001) with PCA having worse scores in all 10 CBI-R categories. Longitudinally, there was no difference between groups on the NPI-Q. However, on the CBI-R, PCA had faster rates of worsening on self-grooming (p = 0.01) and self-dressing (p = 0.01) compared to LPA. CONCLUSIONS Behavioral and neuropsychiatric symptoms are common in PCA and LPA although these symptoms are more common and severe in PCA.
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Affiliation(s)
| | - Tia Coleman
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Marina Buciuc
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Butts AM, Machulda MM, Martin P, Przybelski SA, Duffy JR, Graff-Radford J, Knopman DS, Petersen RC, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Temporal Cortical Thickness and Cognitive Associations among Typical and Atypical Phenotypes of Alzheimer's Disease. J Alzheimers Dis Rep 2022; 6:479-491. [PMID: 36186727 PMCID: PMC9484150 DOI: 10.3233/adr-220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background The hippocampus and temporal lobe are atrophic in typical amnestic Alzheimer's disease (tAD) and are used as imaging biomarkers in treatment trials. However, a better understanding of how temporal structures differ across atypical AD phenotypes and relate to cognition is needed. Objective Our goal was to compare temporal lobe regions between tAD and two atypical AD phenotypes (logopenic progressive aphasia (LPA) and posterior cortical atrophy (PCA)), and assess cognitive associations. Methods We age and gender-matched 77 tAD participants to 50 LPA and 27 PCA participants, all of which were amyloid-positive. We used linear mixed-effects models to compare FreeSurfer-derived hippocampal volumes and cortical thickness of entorhinal, inferior and middle temporal, and fusiform gyri, and to assess relationships between imaging and memory, naming, and visuospatial function across and within AD phenotype. Results Hippocampal volume and entorhinal thickness were smaller bilaterally in tAD than LPA and PCA. PCA showed greater right inferior temporal and bilateral fusiform thinning and LPA showed greater left middle and inferior temporal and left fusiform thinning. Atypical AD phenotypes differed with greater right hemisphere thinning in PCA and greater left hemisphere thinning in LPA. Verbal and visual memory related most strongly to hippocampal volume; naming related to left temporal thickness; and visuospatial related to bilateral fusiform thickness. Fewer associations remained when examined within AD group. Conclusion Atypical AD phenotypes are associated with greater thinning of lateral temporal structures, with relative sparing of medial temporal lobe, compared to tAD. These findings may have implications for future clinical trials in AD.
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Affiliation(s)
- Alissa M. Butts
- Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, WI, USA,External Research Collaborator, Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Division of Neuropsychology, Mayo Clinic, Rochester, MN, USA
| | - Peter Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer L. Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA,Correspondence to: Jennifer L. Whitwell, PhD, Professor of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA. E-mail:
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Ramanan S, Irish M, Patterson K, Rowe JB, Gorno-Tempini ML, Lambon Ralph MA. Understanding the multidimensional cognitive deficits of logopenic variant primary progressive aphasia. Brain 2022; 145:2955-2966. [PMID: 35857482 PMCID: PMC9473356 DOI: 10.1093/brain/awac208] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023] Open
Abstract
The logopenic variant of primary progressive aphasia is characterized by early deficits in language production and phonological short-term memory, attributed to left-lateralized temporoparietal, inferior parietal and posterior temporal neurodegeneration. Despite patients primarily complaining of language difficulties, emerging evidence points to performance deficits in non-linguistic domains. Temporoparietal cortex, and functional brain networks anchored to this region, are implicated as putative neural substrates of non-linguistic cognitive deficits in logopenic variant primary progressive aphasia, suggesting that degeneration of a shared set of brain regions may result in co-occurring linguistic and non-linguistic dysfunction early in the disease course. Here, we provide a Review aimed at broadening the understanding of logopenic variant primary progressive aphasia beyond the lens of an exclusive language disorder. By considering behavioural and neuroimaging research on non-linguistic dysfunction in logopenic variant primary progressive aphasia, we propose that a significant portion of multidimensional cognitive features can be explained by degeneration of temporal/inferior parietal cortices and connected regions. Drawing on insights from normative cognitive neuroscience, we propose that these regions underpin a combination of domain-general and domain-selective cognitive processes, whose disruption results in multifaceted cognitive deficits including aphasia. This account explains the common emergence of linguistic and non-linguistic cognitive difficulties in logopenic variant primary progressive aphasia, and predicts phenotypic diversification associated with progression of pathology in posterior neocortex.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre and School of Psychology, Sydney, Australia
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Cambridge University Centre for Frontotemporal Dementia, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Whitwell JL, Martin PR, Graff-Radford J, Machulda MM, Sintini I, Buciuc M, Senjem ML, Schwarz CG, Botha H, Carrasquillo MM, Ertekin-Taner N, Lowe VJ, Jack CR, Josephs KA. Investigating Heterogeneity and Neuroanatomic Correlates of Longitudinal Clinical Decline in Atypical Alzheimer Disease. Neurology 2022; 98:e2436-e2445. [PMID: 35483899 PMCID: PMC9231842 DOI: 10.1212/wnl.0000000000200336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aims of this work were to compare rates of longitudinal change in neurologic and neuropsychological test performance between the logopenic progressive aphasia (LPA) and posterior cortical atrophy (PCA) variants of atypical Alzheimer disease (AD) and to use unbiased principal component analysis to assess heterogeneity in patterns of change and relationships to demographics and concurrent brain atrophy. METHODS Patients with PCA or LPA who were positive for amyloid and tau AD biomarkers and had undergone serial neurologic and neuropsychological assessments and structural MRI were identified. Rates of change in 13 clinical measures were compared between groups in a case-control design, and principal component analysis was used to assess patterns of clinical change unbiased by clinical phenotype. Components were correlated with rates of regional brain atrophy with tensor-based morphometry. RESULTS Twenty-eight patients with PCA and 27 patients with LPA were identified. Those with LPA showed worse baseline performance and faster rates of decline in naming, repetition, and working memory, as well as faster rates of decline in verbal episodic memory, compared to those with PCA. Conversely, patients with PCA showed worse baseline performance in tests of visuospatial and perceptual function and on the Clinical Dementia Rating Scale and faster rates of decline in visuoperceptual function compared to those with LPA. Principal component analysis showed that patterns of clinical decline were highly heterogeneous across the cohort, with 10 principal components required to explain >90% of the variance. The first principal component reflected overall severity, with higher scores in LPA than PCA reflecting faster decline in LPA, and was related to left temporoparietal atrophy. The second and third principal components were not related to clinical phenotype but showed some relationship to regional atrophy. No relationships were identified between the principal components and age, sex, disease duration, amyloid PET findings, or apolipoprotein genotype. DISCUSSION Longitudinal patterns of clinical decline differ between LPA and PCA but are heterogeneous and related to different patterns of topographic spread. PCA is associated with a more slowly progressive course than LPA.
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Affiliation(s)
- Jennifer L Whitwell
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL.
| | - Peter R Martin
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Irene Sintini
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Marina Buciuc
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Matthew L Senjem
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Christopher G Schwarz
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Minerva M Carrasquillo
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Nilufer Ertekin-Taner
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Val J Lowe
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
| | - Keith A Josephs
- From the Departments of Radiology (J.W., I.S., M.L.S., C.G.S., V.J.L., C.R.J.), Quantitative Health Sciences (P.R.M.), Neurology (J.G.-R., M.B., H.B., K.A.J.), Psychiatry and Psychology (M.M.), and Information Technology (M.L.S.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.M.C., N.E.-T.), Mayo Clinic, Jacksonville, FL
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Clinical Screening for Posterior Cortical Atrophy. Cogn Behav Neurol 2022; 35:104-109. [PMID: 35639011 DOI: 10.1097/wnn.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) is a progressive neurologic syndrome that presents with complex visual deficits. Although PCA is most commonly a form of Alzheimer disease (AD), its early diagnosis is usually delayed due to a lack of understanding for how best to clinically screen for the syndrome. OBJECTIVE To identify neurobehavioral screening tasks for PCA-beyond simple visual constructions-that can be administered in clinic or at bedside. METHOD We compared the performance of 12 individuals who met neuroimaging-supported consensus criteria for PCA with that of 12 matched individuals with typical AD (tAD) and 24 healthy controls (HC) on clinic/bedside tasks measuring (a) complex figure copying, (b) Balint syndrome, (c) visual object agnosia, (d) color identification, (e) figure-ground discrimination, (f) global-local processing, (g) dressing apraxia, (h) ideomotor apraxia, and (i) Gerstmann syndrome. RESULTS All of the individuals with PCA were impaired on the figure-ground discrimination task compared with half of the tAD group and no HC. Approximately half of the PCA group had Balint syndrome, dressing apraxia, and ideomotor apraxia compared with none in the tAD group. Difficulty copying a complex figure, global-local processing impairment, and Gerstmann syndrome did not distinguish between the two dementia groups. CONCLUSION The figure-ground discrimination task can be used successfully as an overall screening measure for PCA, followed by specific tasks for Balint syndrome and dressing and limb apraxia. Findings reinforce PCA as a predominant occipitoparietal disorder with dorsal visual stream involvement and parietal signs with spatiomotor impairments.
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Ramanan S, Foxe D, El-Omar H, Ahmed RM, Hodges JR, Piguet O, Irish M. Evidence for a pervasive autobiographical memory impairment in Logopenic Progressive Aphasia. Neurobiol Aging 2021; 108:168-178. [PMID: 34653892 DOI: 10.1016/j.neurobiolaging.2021.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Although characterized primarily as a language disorder, mounting evidence indicates episodic amnesia in Logopenic Progressive Aphasia (LPA). Whether such memory disturbances extend to information encoded pre-disease onset remains unclear. To address this question, we examined autobiographical memory in 10 LPA patients, contrasted with 18 typical amnestic Alzheimer's disease and 16 healthy Control participants. A validated assessment, the Autobiographical Interview, was employed to explore autobiographical memory performance across the lifespan under free and probed recall conditions. Relative to Controls, LPA patients showed global impairments across all time periods for free recall, scoring at the same level as disease-matched cases of Alzheimer's disease. Importantly, these retrieval deficits persisted in LPA, even when structured probing was provided, and could not be explained by overall level of language disruption or amount of information generated during autobiographical narration. Autobiographical memory impairments in LPA related to gray matter intensity decrease in predominantly posterior parietal brain regions implicated in memory retrieval. Together, our results suggest that episodic memory disturbances may be an under-appreciated clinical feature of LPA.
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Affiliation(s)
- Siddharth Ramanan
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia; Medical Research Council Cognition and Brain Sciences Unit at The University of Cambridge, Cambridge, UK.
| | - David Foxe
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia; The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.
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North C, Desai R, Saunders R, Suárez-González A, Bamiou D, Costafreda SG, de Haan G, Halls G, Heutink J, O'Nions E, Utoomprurkporn N, John A, Stott J. Neuropsychological deficits in Posterior Cortical Atrophy and typical Alzheimer's disease: A meta-analytic review. Cortex 2021; 143:223-236. [PMID: 34464853 DOI: 10.1016/j.cortex.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/13/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
AIMS To identify cognitive tests that best differentiate between Posterior Cortical Atrophy (PCA) and typical Alzheimer's Disease (tAD), as well as PCA and healthy control (HC) participants. METHOD Medline, PsycInfo and Web of Science were systematically searched using terms related to PCA, tAD, and cognitive testing. Seventeen studies were identified, including 441 PCA, 391 tAD, and 284 HC participants. Standardised effect sizes of mean scores were calculated to measure performance differences on cognitive tests for PCA versus tAD and PCA versus HC groups. Meta-analyses used a random effects model. RESULTS The most discriminating cognitive tests for PCA and tAD presentations were measures of visuospatial function and verbal memory. Large, significant effect sizes were produced for all measures of visuospatial function, most notably for Rey-Osterrieth Copy (Hedges' g = -2.79), VOSP Fragmented letters (Hedges' g = -1.73), VOSP Dot Counting (Hedges' g = -1.74), and VOSP Cube Analysis (Hedges' g = -1.98). For measures of verbal memory, the RAVLT delay and Digit Span Backwards produced significant medium effects (Hedges' g = .62 and -.56, respectively). CONCLUSION Establishing a common framework for testing individuals with PCA has important implications for diagnosis and treatment, and forms a practical objective for future research. Findings from this meta-analysis suggest that measures of visuospatial function and verbal memory would form an important part of this framework.
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Affiliation(s)
- Courtney North
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Roopal Desai
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | | | - Doris Bamiou
- UCL Ear Institute, University College London, UK
| | - Sergi G Costafreda
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Gera de Haan
- University of Groningen, Groningen, the Netherlands; Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Georgia Halls
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joost Heutink
- University of Groningen, Groningen, the Netherlands; Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands
| | - Elizabeth O'Nions
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nattawan Utoomprurkporn
- UCL Ear Institute, University College London, UK; Faculty of Medicine, Chulalongkorn University, Thailand
| | - Amber John
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Mendez MF, Khattab YI, Yerstein O. Impaired visual search in posterior cortical atrophy vs. typical Alzheimer's disease. J Neurol Sci 2021; 428:117574. [PMID: 34271285 DOI: 10.1016/j.jns.2021.117574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior cortical atrophy (PCA) is a neurocognitive disorder characterized by difficulty localizing in space. Recognizing PCA is important because it is usually missed early in its course and may result from a number of neurological disorders other than Alzheimer's disease (AD). OBJECTIVE This study aimed to clarify whether impaired visual search tasks of spatial localization distinguished patients with PCA from those with other more typical dementias as well as from healthy control (HC) subjects. METHODS Twelve patients meeting neuroimaging-supported Consensus Criteria for PCA, 12 comparably advanced patients with amnestic-predominant typical AD (tAD), and 24 HC participants were compared on tests of untimed and timed visual search, spatial neglect, mental rotation, environmental orientation, visuospatial construction, and face recognition. RESULTS Only abnormalities in untimed and timed visual search and environmental orientation distinguished the PCA patients from both the tAD group and the HC group without also distinguishing the tAD patients from HC's. The PCA patients also had a tendency to greater difficulty scanning left hemispace compared to HC's. Visuospatial constructions, although worse in PCA, and face recognition were impaired in both dementia groups. CONCLUSIONS These findings support the concept of PCA as a disorder of spatial processing and localization, indicating that visual search tasks are particularly sensitive and specific for detecting PCA and distinguishing it from more typical dementia syndromes.
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Affiliation(s)
- Mario F Mendez
- Departments of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA; Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA; Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, USA.
| | - Youssef I Khattab
- Departments of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), USA
| | - Oleg Yerstein
- Department of Neurology, Lahey Hospital and Medical Center, USA.
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Shea YF, Pan Y, Mak HKF, Bao Y, Lee SC, Chiu PKC, Chan HWF. A systematic review of atypical Alzheimer's disease including behavioural and psychological symptoms. Psychogeriatrics 2021; 21:396-406. [PMID: 33594793 DOI: 10.1111/psyg.12665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) is the commonest cause of dementia, characterized by the clinical presentation of progressive anterograde episodic memory impairment. However, atypical presentation of patients is increasingly recognized. These atypical AD include logopenic aphasia, behavioural variant AD, posterior cortical atrophy, and corticobasal syndrome. These atypical AD are more common in patients with young onset AD before the age of 65 years old. Since medical needs (including the behavioural and psychological symptoms of dementia) of atypical AD patients could be different from typical AD patients, it is important for clinicians to be aware of these atypical forms of AD. In addition, disease modifying treatment may be available in the future. This review aims at providing an update on various important subtypes of atypical AD including behavioural and psychological symptoms.
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Affiliation(s)
- Yat-Fung Shea
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yining Pan
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yiwen Bao
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Shui-Ching Lee
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Patrick Ka-Chun Chiu
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Hon-Wai Felix Chan
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Buciuc M, Whitwell JL, Kasanuki K, Graff-Radford J, Machulda MM, Duffy JR, Strand EA, Lowe VJ, Graff-Radford NR, Rush BK, Franczak MB, Flanagan ME, Baker MC, Rademakers R, Ross OA, Ghetti BF, Parisi JE, Raghunathan A, Reichard RR, Bigio EH, Dickson DW, Josephs KA. Lewy Body Disease is a Contributor to Logopenic Progressive Aphasia Phenotype. Ann Neurol 2021; 89:520-533. [PMID: 33274526 PMCID: PMC8040336 DOI: 10.1002/ana.25979] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe clinical features, [18 F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) metabolism and digital pathology in patients with logopenic progressive aphasia (LPA) and pathologic diagnosis of diffuse Lewy body disease (DLBD) and compare to patients with LPA with other pathologies, as well as patients with classical features of probable dementia with Lewy bodies (pDLB). METHODS This is a clinicopathologic case-control study of 45 patients, including 20 prospectively recruited patients with LPA among whom 6 were diagnosed with LPA-DLBD. We analyzed clinical features and compared FDG-PET metabolism in LPA-DLBD to an independent group of patients with clinical pDLB and regional α-synuclein burden on digital pathology to a second independent group of autopsied patients with DLBD pathology and antemortem pDLB (DLB-DLBD). RESULTS All patients with LPA-DLBD were men. Neurological, speech, and neuropsychological characteristics were similar across LPA-DLBD, LPA-Alzheimer's disease (LPA-AD), and LPA-frontotemporal lobar degeneration (LPA-FTLD). Genetic screening of AD, DLBD, and FTLD linked genes were negative with the exception of APOE ε4 allele present in 83% of LPA-DLBD patients. Seventy-five percent of the patients with LPA-DLBD showed a parietal-dominant pattern of hy pometabolism; LPA-FTLD - temporal-dominant pattern, whereas LPA-AD showed heterogeneous patterns of hypometabolism. LPA-DLBD had more asymmetrical hypometabolism affecting frontal lobes, with relatively spared occipital lobe in the nondominantly affected hemisphere, compared to pDLB. LPA-DLBD had minimal atrophy on gross brain examination, higher cortical Lewy body counts, and higher α-synuclein burden in the middle frontal and inferior parietal cortices compared to DLB-DLBD. INTERPRETATION Whereas AD is the most frequent underlying pathology of LPA, DLBD can also be present and may contribute to the LPA phenotype possibly due to α-synuclein-associated functional impairment of the dominant parietal lobe. ANN NEUROL 2021;89:520-533.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Beth K. Rush
- Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Margaret E. Flanagan
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Bernardino F. Ghetti
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Joseph E. Parisi
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aditya Raghunathan
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R. Ross Reichard
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eileen H. Bigio
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW Non-amnestic (or atypical) presentations of neurodegenerative dementias are underrecognized and underdiagnosed, including posterior cortical atrophy (PCA) syndrome, which is characterized by prominent visuospatial and visuoperceptual dysfunction at presentation. It is most commonly due to Alzheimer's disease pathology, while Lewy body disease, corticobasal degeneration, and prion disease are neuropathological entities that are less frequently associated with PCA. The diagnosis of PCA is often delayed, to the detriment of the patient, and awareness and understanding of PCA will improve detection, prognostication, and treatment. RECENT FINDINGS The natural history of PCA appears to be distinct from typical Alzheimer's disease and significant heterogeneity exists within the PCA syndrome, with the underlying causes of this heterogeneity beginning to be explored. Functional and molecular imaging can assist in better understanding PCA, particularly assessment of network disruptions that contribute to clinical phenotypes. Cerebrospinal fluid biomarkers are useful to detect underlying pathology, but measures of retinal thickness are less promising. There are currently no adequate treatment options for PCA. SUMMARY Continued efforts to characterize PCA are needed, and greater awareness and understanding of atypical presentations of neurodegenerative dementias could serve to elucidate pathobiological mechanisms of underlying disease.
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Yerstein O, Parand L, Liang LJ, Isaac A, Mendez MF. Benson's Disease or Posterior Cortical Atrophy, Revisited. J Alzheimers Dis 2021; 82:493-502. [PMID: 34057092 PMCID: PMC8316293 DOI: 10.3233/jad-210368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND D. Frank Benson and colleagues first described the clinical and neuropathological features of posterior cortical atrophy (PCA) from patients in the UCLA Neurobehavior Program. OBJECTIVE We reviewed the Program's subsequent clinical experience with PCA, and its potential for clarifying this relatively rare syndrome in comparison to the accumulated literature on PCA. METHODS Using the original criteria derived from this clinic, 65 patients with neuroimaging-supported PCA were diagnosed between 1995 and 2020. RESULTS On presentation, most had visual localization complaints and related visuospatial symptoms, but nearly half had memory complaints followed by symptoms of depression. Neurobehavioral testing showed predominant difficulty with visuospatial constructions, Gerstmann's syndrome, and Balint's syndrome, but also impaired memory and naming. On retrospective application of the current Consensus Criteria for PCA, 59 (91%) met PCA criteria with a modification allowing for "significantly greater visuospatial over memory and naming deficits." There were 37 deaths (56.9%) with the median overall survival of 10.3 years (95% CI: 9.6-13.6 years), consistent with a slow neurodegenerative disorder in most patients. CONCLUSION Together, these findings recommend modifying the PCA criteria for "relatively spared" memory, language, and behavior to include secondary memory and naming difficulty and depression, with increased emphasis on the presence of Gerstmann's and Balint's syndromes.
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Affiliation(s)
- Oleg Yerstein
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Leila Parand
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Adrienne Isaac
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Mario F. Mendez
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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